Provider Demographics
NPI:1417727637
Name:BERNAL LEON, LETICIA (ARNP)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:BERNAL LEON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 W FLAGLER ST STE 406
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1644
Mailing Address - Country:US
Mailing Address - Phone:305-456-3879
Mailing Address - Fax:
Practice Address - Street 1:3990 W FLAGLER ST STE 406
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1644
Practice Address - Country:US
Practice Address - Phone:305-456-3879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11030021363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty